False-negative HIV-1 polymerase chain reaction in a 15-month-old boy with HIV-1 subtype C infection

Polymerase chain reaction (PCR) testing is the gold standard for determining the HIV status in children <18 months of age. However, when clinicalmanifestations are not consistent with laboratory results, additional investigation is required. We report a 15-month-old HIV-exposed boy referredto our hospital after he had been admitted several times for infectious diseases. A rapid antibody test on the child was positive, while routinediagnostic HIV PCRs using the Roche COBAS Ampliprep/COBAS TaqMan HIV Qual Test were negative at 6 weeks, 6 months, 7 months and15 months. In addition, the same PCR test performed on the HIV-infected mother was also negative. Alternative PCR and viral load assays usingdifferent primer sets detected HIV RNA or proviral DNA in both child and mother. Gag sequences from the child and his mother classified bothinfections as HIV-1 subtype C, with very rare mutations that may have resulted in PCR assay primer/probe mismatch. Consequently, the child wascommenced on antiretroviral therapy and made a remarkable recovery. These findings indicate that more reliable PCR assays capable of detectinga wide range of HIV subtypes are desirable to circumvent the clinical problems created by false-negative PCR results

Diagnostic accuracy of Xpert® MTB/RIF Ultra for childhood tuberculosis in West Africa - a multicentre pragmatic study

OBJECTIVE: To evaluate the performance of Xpert MTB/RIF Ultra ('Ultra') for diagnosis of childhood tuberculosis (TB) within public health systems. METHODS: In this cross-sectional study, children aged <15 years with presumptive pulmonary TB were consecutively recruited and evaluated for TB at tertiary-level hospitals in Benin, Mali and Ghana. Bivariate random-effects models were used to determine the pooled sensitivity and specificity of Ultra against culture. We also estimated its diagnostic yield against a composite microbiological reference standard (cMRS) of positive culture or Ultra. RESULTS: Overall, 193 children were included in the analyses with a median (IQR) age of 4.0 (1.1 - 9.2) years, 88 (45.6%) were female, and 36 (18.7%) were HIV-positive. Thirty-one (16.1%) children had confirmed TB, 39 (20.2%) had unconfirmed TB, and 123 (63.7%) had unlikely TB. The pooled sensitivity and specificity of Ultra verified by culture were 55.0% (95% CI: 28.0 - 79.0%) and 95.0% (95% CI: 88.0 - 98.0%), respectively. Against the cMRS, the diagnostic yield of Ultra and culture were 67.7% (95% CI: 48.6 - 83.3%) and 70.9% (95% CI: 51.9 - 85.8%), respectively. CONCLUSION: Ultra has suboptimal sensitivity in children with TB that were investigated under routine conditions in tertiary-level hospitals in three West African countries

Proximate predictors of early antenatal registration among Nigerian pregnant women

Background : Provision of antenatal care (ANC) is included in the pillars of maternal health care promoted as effective answers to maternal mortality. Early antenatal registration has been linked with optimal utilization and appreciable reduction of perinatal morbidity and mortality. This study aimed to determine the profile and possible predictors of pregnant women who presented early for antenatal registration. Methods : A cross-sectional study was conducted among 796 women presented for antenatal registration at a tertiary hospital. Information was obtained by a self-administered open- and closed-ended questionnaire and analyzed with Statistical Package of Social Science (SPSS) 12.0 software. Results : The mean gestational age at booking was 20 weeks. Univariate analysis showed that first trimester booking was significantly with more educated women, professionals, women of lower parity and those who have had previous stillbirths (P &lt; 0.05). Low parity (OR 1.76, 95% CI 2.79-1.11) and previous stillbirth (OR 2.97, 95% CI 1.61-5.51) were significant predictors of early booking on multivariate analysis. Conclusion : Long-term advocacy and investment in female education will contribute significantly to primary prevention of late or non-attendance of ANC. Pre-conception clinics and community awareness campaigns would be necessary tools to reach these women and encourage them to register early when pregnant.Arri\ue8re-plan: Soins prestation de pr\ue9natals (ANC) sont inclus dans les piliers de soins de sant\ue9 maternelle promu comme des r\ue9ponses efficaces \ue0 la mortalit\ue9 maternelle. Enregistrement pr\ue9natals d\ue9but a \ue9t\ue9 li\ue9 avec l\u2019utilisation optimale et une r\ue9duction sensible de la mortalit\ue9 et de morbidit\ue9 p\ue9rinatale. Cette \ue9tude visait \ue0 d\ue9terminer les indicateurs de profil et possible des femmes enceintes qui a pr\ue9sent\ue9 au d\ue9but pour enregistrement pr\ue9natals. M\ue9thodes: une \ue9tude transversale a \ue9t\ue9 r\ue9alis\ue9e chez les 796 femmes pr\ue9sent\ue9es \ue0 l\u2019immatriculation pr\ue9natals dans un h\uf4pital tertiaire. Information a \ue9t\ue9 obtenue par un questionnaire auto-administr\ue9 ouvertes et ferm\ue9es et analys\ue9e avec logiciel statistique package de sciences sociales (SPSS) 12.0. R\ue9sultats: L\u2019\ue2ge gestationnel moyenne \ue0 la r\ue9servation a \ue9t\ue9 de 20 semaines. Unidimensionnelle analyse a montr\ue9 que premier quadrimestre r\ue9servation \ue9tait sensiblement plus \ue9duqu\ue9e femmes, professionnels, femmes de parit\ue9 inf\ue9rieure et ceux qui ont eu des pr\ue9c\ue9dents mort-n\ue9s (P &lt; 0,05). Faible parit\ue9 (1,76 OR, 95% CI 2.79\u20131.11) et mortinaissance pr\ue9c\ue9dente (2.97 OR, 1.61\u20135.51 CI de 95%) \ue9taient des indicateurs importants de r\ue9servation anticip\ue9e sur analyse multivari\ue9e. Conclusion: Sensibilisation \ue0 long terme et les investissements dans l\u2019\ue9ducation des filles contribuera grandement\ue0 la pr\ue9vention primaire de retard ou de non-comparution de ANC. Pre-conception cliniques et des campagnes de sensibilisation communautaire serait les outils n\ue9cessaires pour atteindre ces femmes et de les encourager\ue0 Inscrivez-vous t\uf4t lorsque enceinte

Proximate predictors of early antenatal registration among Nigerian pregnant women

Background : Provision of antenatal care (ANC) is included in the pillars of maternal health care promoted as effective answers to maternal mortality. Early antenatal registration has been linked with optimal utilization and appreciable reduction of perinatal morbidity and mortality. This study aimed to determine the profile and possible predictors of pregnant women who presented early for antenatal registration. Methods : A cross-sectional study was conducted among 796 women presented for antenatal registration at a tertiary hospital. Information was obtained by a self-administered open- and closed-ended questionnaire and analyzed with Statistical Package of Social Science (SPSS) 12.0 software. Results : The mean gestational age at booking was 20 weeks. Univariate analysis showed that first trimester booking was significantly with more educated women, professionals, women of lower parity and those who have had previous stillbirths (P < 0.05). Low parity (OR 1.76, 95% CI 2.79-1.11) and previous stillbirth (OR 2.97, 95% CI 1.61-5.51) were significant predictors of early booking on multivariate analysis. Conclusion : Long-term advocacy and investment in female education will contribute significantly to primary prevention of late or non-attendance of ANC. Pre-conception clinics and community awareness campaigns would be necessary tools to reach these women and encourage them to register early when pregnant.Arrière-plan: Soins prestation de prénatals (ANC) sont inclus dans les piliers de soins de santé maternelle promu comme des réponses efficaces à la mortalité maternelle. Enregistrement prénatals début a été lié avec l’utilisation optimale et une réduction sensible de la mortalité et de morbidité périnatale. Cette étude visait à déterminer les indicateurs de profil et possible des femmes enceintes qui a présenté au début pour enregistrement prénatals. Méthodes: une étude transversale a été réalisée chez les 796 femmes présentées à l’immatriculation prénatals dans un hôpital tertiaire. Information a été obtenue par un questionnaire auto-administré ouvertes et fermées et analysée avec logiciel statistique package de sciences sociales (SPSS) 12.0. Résultats: L’âge gestationnel moyenne à la réservation a été de 20 semaines. Unidimensionnelle analyse a montré que premier quadrimestre réservation était sensiblement plus éduquée femmes, professionnels, femmes de parité inférieure et ceux qui ont eu des précédents mort-nés (P < 0,05). Faible parité (1,76 OR, 95% CI 2.79–1.11) et mortinaissance précédente (2.97 OR, 1.61–5.51 CI de 95%) étaient des indicateurs importants de réservation anticipée sur analyse multivariée. Conclusion: Sensibilisation à long terme et les investissements dans l’éducation des filles contribuera grandementà la prévention primaire de retard ou de non-comparution de ANC. Pre-conception cliniques et des campagnes de sensibilisation communautaire serait les outils nécessaires pour atteindre ces femmes et de les encouragerà Inscrivez-vous tôt lorsque enceinte

Clinical characterisation and phylogeny of respiratory syncytial virus infection in hospitalised children at Red Cross War Memorial Children’s Hospital, Cape Town

Abstract Background Respiratory syncytial virus (RSV) is a major cause of lower respiratory tract infection in young children in both the community and hospital setting. Methods The clinical presentation, patient and phylogenetic characteristicsof laboratory-confirmed cases of RSV, as well as risk factors for nosocomial infectionat Red Cross War Memorial Children’s Hospital in Cape Town were analysed. A multiplex PCR assay that detects 7 respiratory viruses was used to identify RSV nucleic acid on respiratory specimens. Results A total of 226 children were studied, ages ranging between 1 week and 92.5 months (median: 2.8 months, IQR: 1.3–6.3 months) and 51.8 % were males. The median duration of symptoms prior to diagnosis was 2 days (IQR: 1–4 days). Nosocomial infections wereidentified in 22 (9.7 %) children. There were pre-existing medical conditions in 113 (50.0 %) excluding HIV, most commonly prematurity (n = 58, 50.0 %) and congenital heart disease (n = 34, 29.3 %). The commonest presenting symptoms were cough (196, 86.7 %), difficulty in breathing (115, 50.9 %) and fever (91, 41.6 %).A case fatality rate of 0.9 % was recorded. RSV group A predominated (n = 181, 80.1 %) while group B accounted for only 45 (19.9 %) of the infections. The prevalent genotypes were NA1 (n = 127,70.1 %), ON1 (n = 45,24.9 %) and NA2 (n = 9,5.0 %) for group A while the only circulating RSV B genotype was BA4. There was no significant difference in the genotype distribution between the nosocomial and community-acquired RSV infections. Age ≥ 6 months was independently associated with nosocomial infection. Conclusions A large percentage of children with RSV infection had pre-existing conditions. Approximately one tenth of the infections were nosocomial with age 6 months or older being a risk factor. Though both RSV groups co-circulated during the season, group A was predominant and included the novel ON1 genotype. Continued surveillance is necessary to identify prevalent and newly emerging genotypes ahead of vaccine development and efficacy studies

L’acceptabilité de l’adoption des enfants comme option de conduite à tenir devant la stérilité au Nigéria : Evidence à partir d’une discussion à groupe cible

Infertility remains a global health challenge with devastating psycho-social consequences in many African communities. Adoption that may serve as an alternative strategy for the affected couples is not widely practiced. This study was conceptualized to assess the acceptability of child adoption as a management option by Nigerians. Twelve focus group discussions were held involving three communities stratified into inner core, transitory and peripheral, within Ibadan metropolis, South-Western Nigeria from May to July 2008. The participants were purposively selected based on gender and age group. The barriers mentioned were cultural practices, stigmatization, financial implications, and procedural bottle-necks. Measures suggested to curb these negative attitudes were advocacy, community mobilization and enactment of supportive law that will protect all parties involved (Afr J Reprod Health 2009; 13[1]:79-91)..La stérilité demeure un défi de la santé partout dans le monde, ayant des conséquences psycho-sociales désastreuses dans plusieurs communautés africaines. L’adoption qui devrait servir de stratégie alternative pour les couples affectés n’est pas très répandue. Nous avons conçu cette étude pour évaluer l’acceptabilité de l’adoption des enfants comme option à tenir par les Nigérians devant la stérilité. Il y a eu douze discussions à groupe cible qui concernaient trois communautés qui ont été stratifiées ainsi : parties intérieure, transitoire et périphérique, a l’intérieur de la métropole d’Ibadan au sud-ouest du Nigéria du mois de mai jusqu’ au mois de juillet 2008. Les participants ont été deliberamment sélectionnés selon le sexe et le groupe d’âge. Les obstacles mentionnés étaient les pratiques culturelles, la stigmatisation, les implications financières et les difficultés liées au procès de l’adoption. Pour mettre un frein à ces attitudes négatives, nous avons suggéré la plaidoirie en faveur de l’adoption, la mobilisation de la communauté et la promulgation d’une loi favorable qui protégera toutes les parties concernées (Afr J Reprod Health 2009; 13[1]:79-91)

Prevalence and clinical pattern of paediatric HIV infection at the University College Hospital, Ibadan, Nigeria: a prospective cross-sectional study

Abstract Background The prevalence of Paediatric HIV infection is largely unknown in many countries in sub-Saharan Africa. This study was aimed at determining the prevalence, clinical pattern of HIV infection and outcome among new patients aged Methods A prospective cross sectional study was carried out using the provider initiated HIV testing and counselling (PITC) model. HIV rapid test in parallel was used for screening and confirmation was with HIV DNA PCR in children Results A total of 600 children were enrolled with ages ranging between one day and 179 months. Male: female ratio was 1.2:1. HIV seroprevalence was 12.3% and after confirmatory tests, the prevalence was 10%. Fourteen (37.8%) of the children aged less 18 months were exposed but not infected. Mother-to-child transmission accounted for 93.3% of cases. Features predictive of HIV infection were diarrhoea, cough, weight loss, ear discharge generalized lymphadenopathy, presence of skin lesions, parotid swelling and oral thrush. About 75% presented in advanced or severe clinical stages of the disease, 56.8% had severe immunodeficiency while 50% had viral loads more than 100,000 copies/ml. Mortality rate was 14.3% among HIV positive compared with 11.3% in HIV negative children but was not significant. Among the HIV positive children, 26.7% were orphans. Conclusions The prevalence rate of HIV infection among new patients screened using the PITC model was high, majority resulting from mother-to-child transmission. Most children presented in advanced stages of the disease and mortality rate among them was high. Though, the study site being a referral centre might have contributed to the high prevalence observed in this study, there is a need to expand access to PMTCT services, ensure implementation of PITC in paediatric settings and expand support services for HIV infected children.</p

Blood Transfusion–Associated HIV Infection in Children in Ibadan, Nigeria

Introduction: This study describes the epidemiologic features and clinical course of children with blood transfusion-associated HIV infection (TAHI) in Ibadan, Nigeria. Methodology: All children diagnosed to have TAHI at the University College Hospital, Ibadan, were studied and compared with children who acquired HIV vertically using the pediatric HIV database in the hospital. Results: Transfusion-associated HIV infection accounted for 14 (2.3%) of the 597 children diagnosed to have HIV infection between January 2004 and December 2011. The mean age at diagnosis of TAHI was 10.2 years and that of vertically acquired HIV infection was 3.9 years ( P < .001). In 9 cases, blood transfusion took place in private hospitals and in 5 cases in public hospitals. Median interval between infection and diagnosis of AIDS was 84 months in cases with TAHI and 48 months in vertically acquired cases ( P = .542). Conclusion: Optimal blood safety practices are advocated for prevention of TAHI in Nigeria

Things must not fall apart: the ripple effects of the COVID-19 pandemic on children in sub-Saharan Africa

Zero to 19 year-old children in sub-Saharan Africa bear a disproportionate proportion of the global burden of communicable and non-communicable diseases. Significant public health gains have been made in the fight against these diseases, however, factors such as underequipped health systems, disease outbreaks, conflict, and political instability continue to challenge prevention and control. The novel coronavirus disease (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) introduces new challenges to public health programs in sub-Saharan Africa. Of particular concern are programs targeting major conditions among children, such as undernutrition, vaccine-preventable pneumonia and diarrhea, malaria, tuberculosis, HIV, and sickle cell disease. This article focuses on the impact of the COVID-19 pandemic on child health in sub-Saharan Africa. We review the epidemiology of major pediatric diseases and, referencing modeling projections, discuss the short- and long-term impact of the pandemic on major disease control. We deliberate on potential complications of SARS-CoV-2 co-infections/co-morbidities and identify critical social and ethical issues. Furthermore, we highlight the paucity of COVID-19 data and clinical trials in this region and the lack of child participants in ongoing studies. Lastly, approaches and interventions to mitigate the pandemic’s impact on child health outcomes are discussed